Bridge Pontic Overview

Bridge Pontic

• A bridge pontic is a prosthetic appliance permanently attached to remaining teeth to replace missing teeth.
• It replaces a missing natural tooth, both aesthetically and functionally.
• It needs to be compatible with continued oral health and comfort.
• Proper preparation involves a careful analysis of critical dimensions of edentulous areas: mesiodistal width, occlusocervical distance, buccolingual diameter, and location of the residual ridge.
• Particular attention to form and shape of the gingival surface is crucial to prevent irritation of the residual ridge and meet hygienic requirements
• Pontics can be categorized by whether they contact the oral mucosa or not (with or without mucosal contact).
• Examples of pontics with mucosal contact include ridge lap, modified ridge lap, and ovate pontics
• Examples of pontics without mucosal contact are bullet, hygienic, and sanitary pontics
• A pontic's function is to restore mastication, speech, and esthetics (impacting patient psychology).
• To maintain inter-arch and intra-arch tooth relationships, and gingival health (influencing occlusal harmony).
• Pretreatment assessment (diagnostic casts and waxing) is vital for optimal pontic design.
• This assessment considers pontic space, residual ridge contour, and surgical modifications.

Pontic space

• An FPD (fixed partial denture) prevents adjacent teeth from tilting or drifting into the edentulous space.
• If movement has already occurred, the space available for the pontic may be reduced, complicating fabrication.
• Creating an acceptable appearance without orthodontic repositioning of abutment teeth is often impossible, especially in cases needing esthetics.

Residual ridge contour

• Carefully evaluate edentulous ridge contour and topography during treatment planning.
• Ideally, the ridge should have a smooth, regular surface of attached gingiva fostering a plaque-free environment.
• Also, the ridge's height and width must accommodate a pontic that appears to emerge from the ridge and resemble neighboring teeth.
• Loss of residual ridge contour can lead to esthetic issues (black triangles), food impaction, and saliva percolation during speech.
• Siebert categorized residual ridge deformities into three classes: I (faciolingual loss of tissue width with normal ridge height), II (loss of ridge height with normal ridge width), and III (combination of loss in both dimensions).

Surgical Modifications

• A high incidence of residual ridge deformity follows anterior tooth loss.
• Class II and III defects are common, and patients with these often express dissatisfaction with the esthetics of their fixed partial dentures.
• Preprosthetic surgery to augment such ridges is often considered.
• Class I defects are infrequent and often less esthetic–challenging, making surgical ridge-width augmentation uncommon.
• If needed, roll or pouch techniques (for Class I) and the interpositional or onlay grafts (for Class II and III) are surgical options.
• Onlay grafts gain both ridge height and width, suitable for Class III defects.

Gingival Architecture Preservation

• Alveolar process preservation can be accomplished using immediate restorative and periodontal intervention at tooth removal time.
• Conditioning the extraction site and providing a healing matrix preserve the pre-extraction gingival architecture ("socket").

Pontic Classification

• Pontics are categorized into those that contact the oral mucosa and those that do not.
• Anterior pontics require excellent adaptation to the tissue for esthetic appearance.
• Posterior pontic contours can be altered for better oral hygiene.
• Types of pontics include sanitary/hygienic, modified sanitary/hygienic, saddle/ridge-lap, conical, and ovate, differentiated by design (mucosal contact or not) and material (metal, ceramic, acrylic, or combinations).

Pontic function

• Biological considerations focus on ridge contact without pressure, convex gingival surfaces, minimal tissue contact, adequate embrasures, ridge preservation, abutment/opposing teeth maintenance, and suitable pontic material.
• Mechanical considerations encompass material selection (e.g., metal-ceramic, resin-veneered, or fiber-reinforced), framework design, tooth preparation, and occlusion, ensuring sufficient support and avoiding mechanical failure (e.g. sharp angles).
• Esthetic concerns involve replicating the form, contours, incisal edge, and color of adjacent teeth, attentive shaping of the labial surface near the pontic-tissue junction for a natural appearance, and consideration of potential width discrepancies.
  • Historical prefabricated pontics include the Trupontic, interchangeable facings, pin facings, modified pin facings, and reverse pin facings, and various classifications of flat back, longpin facings, and pontips.

Ideal Pontic

• Ideally, pontics should be biologically, mechanically, and aesthetically sound. Biologic factors include healthy tissue maintenance, ease of cleaning, and minimal contact pressure with the ridge. Mechanical strength is essential for resisting functional forces and deformation, ensuring normal function. The pontic should match the appearance of the missing tooth, replicating its form and contours for esthetic appeal.
• Maintaining proper tooth/gingival contacts is important for biological and esthetics factors

Principles of Pontic Design

• The successful pontic combines biological, mechanical, and esthetic principles.
• A biologically suitable pontic touches but does not exert pressure on the ridge; it has a convex gingival surface with minimal tissue contact, and adequate proximal embrasures.

This quiz explores the essential aspects of bridge pontics, including their functions, classifications, and the critical dimensions involved in their preparation. Learn about different types of pontics, their compatibility with oral health, and the importance of gingival surface shape for comfort and hygiene.